Towards rational approaches of health care utilization in complex patients: an exploratory randomized trial comparing a novel combined clinic to multiple specialty clinics in patients with renal disease-cardiovascular disease-diabetes

Weber, Catherine; Beaulieu, Monica; Djurdjev, Ognjenka; Er, Lee; Taylor, Paul A.; Ignaszewski, Andrew; Burnett, Shelley; Levin, Adeera

doi:10.1093/ndt/gfr292

Cited by 24 publications

(52 citation statements)

References 9 publications

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“…Clinical improvements such as these should be associated with overall reduction in cost of care. Applied to the 21,309 patients from a population of 1,000,000, a 5% reduction in the cost of care of CKD, very modest compared to the cost reductions of 20–51% reported by others , would be projected to save $17,500,000 in stage 3b, $8,000,000 in stage 4, and $2,500,000 million in stage 5, for a total savings of $28,000,000 per year.…”

Section: Cost Savings From Decreasing Cost Of Care Within Each Ckd Stagementioning

confidence: 88%

Going Upstream: Coordination to Improve CKD Care

Kapoian

Taylor

Meyer

2016

Seminars in Dialysis

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Care coordination for patients with chronic kidney disease has been shown to be effective in improving outcomes and reducing costs. However, few patients with CKD benefit from this systematic management of their kidney disease and other medical conditions. As a result, outcomes for patients with kidney disease are not optimal, and their cost of care is increased. For those patients who transition to kidney failure treatment in the United States, the transition does not go as well as it could. The effectiveness of treatments to delay progression of kidney disease in contemporary clinical practice does not match the efficacy of these treatments in clinical trials. Conservative care for kidney disease, which should be an option for patients who are very old and very sick, is not considered often enough or seriously enough. Opportunities for early and even pre‐emptive transplantation are missed, as are opportunities for home dialysis. The process of dialysis access creation is rarely optimal. The consequence is care which is not as good as it could be, and much more expensive than it should be. We describe our initial efforts to implement care coordination for chronic kidney disease in routine clinical care and attempt to project some of the benefits to patients and the cost savings.

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Section: Cost Savings From Decreasing Cost Of Care Within Each Ckd Stagementioning

confidence: 88%

Going Upstream: Coordination to Improve CKD Care

Kapoian

Taylor

Meyer

2016

Seminars in Dialysis

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“…It has been used to show that CKD patients managed in multi-disciplinary care clinics have better metabolic parameters and improved survival on dialysis compared to those managed by nephrologists [14]. Further, comprehensive data obtained from PROMIS has been used to identify substantial cost savings by managing CKD patients in a combined specialist clinic, describe provincial variability in testing for hepatitis B immune status in renal patients, and identify rare but severe complications from dialyzer membranes [15-17]. The model of integrating data collection into health care delivery has already proven effective in BC in all-cause CKD, and it is anticipated that similar results will be seen in patients with glomerular disease.…”

Section: Utility and Discussionmentioning

confidence: 99%

An overview of the British Columbia Glomerulonephritis network and registry: integrating knowledge generation and translation within a single framework

et al. 2013

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BackgroundGlomerulonephritis (GN) is a group of rare kidney diseases with a substantial health burden and high risk of progression to end-stage renal disease. Research in GN has been limited by poor availability of large comprehensive registries. Substantial variations in access to and administration of treatment and outcomes in GN have been described. Leveraging provincial resources and existing infrastructure, the British Columbia (BC) GN Network is an initiative which serves to combine research and clinical care objectives. The goal of the BC GN Network is to coordinate and improve health care, including robust data capture, on all patients with GN in BC, a Canadian province of over 4.6 million people. This provincial initiative will serve as a model for Canadian or other national and international endeavours.DescriptionThe BC Provincial Renal Agency (BCPRA) is the provincial governmental agency responsible for health delivery for all kidney patients in BC. The BC GN Network has been created by the BCPRA to ensure high quality and equitable access to care for all patients with GN and is a platform for evidence based clinical care programs and associated health policy. All patients with biopsy-proven GN are registered at the time of kidney biopsy into the BCPRA provincial database of kidney disease patients, forming the BC GN Registry. Thereafter, all laboratory results and renal related outcomes are captured automatically. Histology data and core clinical variables are entered into the database. Additional linkages between the GN Registry and administrative databases ensure robust capture of medications, hospital admissions, health care utilization, comorbidities, cancer and cardiac outcomes, and vital statistics.ConclusionsThe BC GN Network and Registry is a unique model in that it combines robust data capture, data linkages, and health care delivery and evaluation into one integrated system. This model utilizes existing health infrastructure to prospectively capture population level data on patients with GN, producing a rich dataset capable of real-time identification and evaluation of GN health policy initiatives, of supporting observational cohort studies and health services research in GN, and of facilitating patient recruitment into GN clinical trials.

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“…The HND center is the second of its kind in the world, after a similar center at St Paul's hospital Vancouver, Canada. 20 The goal of the outpatient center is to offer comprehensive care to HND patients in an integrated, multidisciplinary, and person-centered manner to improve care coordination, reduce and replace visits to a variety of doctors and nurses, and within a period of one-year, develop sustainable care management plan that can be handed-off to primary care. Upon the HND center's establishment in 2013, clinical and health systems' researchers were tasked to design a research program to compare clinical outcomes, patient experience and costs of HND center care to that of traditional "siloed" care processes.…”

Section: Intervention (Hnd Center)mentioning

confidence: 99%

“…One published empirical study explores the effects of multidisciplinary care interventions on care utilization patterns of HND patients, but it measured care utilization through hospital admissions only. 20 The aims of this study were to describe the characteristics of HND patients and to explore the initial effects of a multidisciplinary and person-centered care on total care utilization.…”

Section: Introductionmentioning

confidence: 99%

<p>Extreme Consumers of Health Care: Patterns of Care Utilization in Patients with Multiple Chronic Conditions Admitted to a Novel Integrated Clinic</p>

Rafiq¹,

Keel²,

Mazzocato³

et al. 2019

JMDH

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Purpose: Patients with multiple chronic conditions (MCC) of diabetes, cardiovascular and kidney diseases; hereafter referred to as HND (heart/cardiac-, nephrology-, diabetes mellitus-) patients, are high utilizers of health care. However, the care received is often insufficiently coordinated between different specialties and health-care providers. This study aims to describe the characteristics of HND patients and to explore the initial effects of a multidisciplinary and person-centered care on total care utilization. Patients and Methods: We conducted a sub-study of HND patients recruited in an ongoing randomized trial CareHND (NCT03362983). Descriptive statistics of patient characteristics, including diagnostic data and Charlson Comorbidity Index scores, informed a comparison of care utilization patterns between HND patient care and traditional care. Diagnostic and care utilization data were collected from a regional database. Wilcoxon signed ranked sum tests were performed to compare care utilization frequencies between the two groups. Results: Patients included in the study were care-intensive with several diagnoses and experienced a high level of variation in care utilization and diagnoses profiles. HND patients were sicker than their counterparts in the control group. Utilization indicators were similar between the two arms. There was some indication that the HND center is beginning to perform as expected, but no results were statistically significant. Conclusion: This study sits among many studies reporting difficulties obtaining statistically significant findings for MCC patients. However, previous research has shown that the key components of this intervention, such as integrated, multidisciplinary, inter-professional collaboration within patient-centered care have had a positive effect on health-care outcomes. More innovative methods beyond the RCT, such as machine learning should be explored to evaluate the impact of integrated care interventions on care utilization.

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Towards rational approaches of health care utilization in complex patients: an exploratory randomized trial comparing a novel combined clinic to multiple specialty clinics in patients with renal disease-cardiovascular disease-diabetes

Abstract: Medical care of complex patients may be delivered in a single combined specialty clinic as compared to multiple disease specific clinics without compromising patient care or important health outcomes, with demonstrable outpatient costs savings.

Cited by 24 publications

References 9 publications

Going Upstream: Coordination to Improve CKD Care

Going Upstream: Coordination to Improve CKD Care

An overview of the British Columbia Glomerulonephritis network and registry: integrating knowledge generation and translation within a single framework

<p>Extreme Consumers of Health Care: Patterns of Care Utilization in Patients with Multiple Chronic Conditions Admitted to a Novel Integrated Clinic</p>

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